title: Health care providers' perspectives on low HPV vaccine uptake and adherence in Appalachian Kentucky.
abstract: OBJECTIVE
  Previous intervention research conducted in Appalachian Kentucky resulted in extremely low uptake and adherence to the human papillomavirus (HPV) vaccine among women ages 18-26, despite provision of free vaccine. Because of these findings, the purpose of this qualitative, follow-up study was to elicit health care providers' perspectives on barriers and facilitators to HPV vaccination and suggested strategies for improving vaccination rates.
  
  
  METHODS
  Researchers conducted semi-structured qualitative interviews with a purposive sample of eight health care providers (seven nursing professionals, one physician) at the health clinic where the original HPV vaccination intervention took place. Interviews were audio-recorded and transcribed and authors used a constant-comparative method to analyze the data.
  
  
  RESULTS
  Significant themes emerged from the interviews, centering around two primary issues: vaccine uptake and vaccine adherence. Related to uptake, health care providers identified perceived patient barriers and inadequate HPV vaccine education. They also identified the vaccine schedule and clinic-centered communication deficiencies as adherence-related barriers.
  
  
  CONCLUSIONS
  These Appalachian Kentucky health care providers provided important insights into barriers and facilitators to HPV vaccine uptake and adherence that need to be readily addressed in this community. As informed by these providers, several suggestions for improving HPV vaccination, such as more targeted education efforts and patient-centered reminder systems, may be applicable to other nursing professionals working in rural and medically underserved communities.
authors.affiliation: Department of Communication, University of Kentucky College of Communication and Information, Lexington, Kentucky 40536-0003, USA.
authors.forename: Katharine J
authors.initials: KJ
authors.lastname: Head
authors.forename: Robin C
authors.initials: RC
authors.lastname: Vanderpool
authors.forename: Laurel A
authors.initials: LA
authors.lastname: Mills
mesh_terms: D000293:Adolescent; D000328:Adult; D001291:Attitude of Health Personnel; D005260:Female; D005500:Follow-Up Studies; D006282:Health Personnel / Q000523:psychology* / Q000706:statistics & numerical data; D006297:Health Services Accessibility; D006801:Humans; D007629:Kentucky; D008875:Middle Aged; D053918:Papillomavirus Vaccines / Q000008:administration & dosage* / Q000191:economics; D010349:Patient Compliance / Q000706:statistics & numerical data*; D036301:Qualitative Research; D019035:Rural Health Services; D014611:Vaccination / Q000706:statistics & numerical data*; D055815:Young Adult
chemical_list: D053918:Papillomavirus Vaccines
keywords: cancer; health behaviors; immunization; perceptions; qualitative research; rural health; women's health